Gillen S, Wilhelm D, Meining A, Fiolka A, Doundoulakis E, Schneider A, von Delius S, Friess H, Feussner H
Department of Surgery, Technische Universität München, Klinikum Rechts der Isar, Munich, Germany.
Endoscopy. 2009 May;41(5):395-9. doi: 10.1055/s-0029-1214620. Epub 2009 May 5.
The ELITE (endoscopic-laparoscopic interdisciplinary training entity) trainer is a new ex vivo model designed to train conventional laparoscopic and endoscopic skills and to perform hybrid interventions. The aim of the present study was to assess its usefulness for natural orifice transluminal endoscopic surgery (NOTES) procedures.
A group of 30 participants (eight gastroenterologists, 22 surgeons) ranging from novices to experts completed the following tasks. Via a trans-sigmoidal approach, anchor points in each quadrant in the abdominal cavity had to be reached. Each participant performed five consecutive courses. The time needed to perform the experiment was evaluated. In a second step to assess advanced skill for NOTES in an external face validation, 20 randomly selected individuals performed a cholecystectomy via the same trans-sigmoidal access.
All participants passed a significant learning curve during the assessment (total time needed: 473.1 +/- 178.5 seconds for first pass vs. 321.9 +/- 182.0 seconds for fifth pass; P = 0.02, Wilcoxon test). There were 15 novices and 15 endoscopy experts. Significant differences were observed for the total time required to perform the respective procedures between these two groups (first pass: 394.3 +/- 176.6 seconds for experts vs. 531.9 +/- 166.7 seconds for novices; P = 0.040, Mann-Whitney test). Furthermore, NOTES cholecystectomies could successfully be simulated. Participants considered the ELITE to represent a useful simulator for NOTES.
The newly developed ELITE trainer is a suitable tool to train NOTES techniques. Experts could reliably be distinguished from novices and a significant progress by training could be demonstrated.
ELITE（内镜-腹腔镜跨学科训练实体）训练器是一种新型离体模型，旨在训练传统腹腔镜和内镜技能并实施混合干预。本研究的目的是评估其在经自然腔道内镜手术（NOTES）操作中的实用性。
一组30名参与者（8名胃肠病学家，22名外科医生），从新手到专家，完成了以下任务。通过经乙状结肠途径，必须到达腹腔每个象限的锚定点。每位参与者连续进行五个疗程。评估完成实验所需的时间。在第二步中，为了在外部面部验证中评估NOTES的高级技能，20名随机选择的个体通过相同的经乙状结肠途径进行了胆囊切除术。
在评估过程中，所有参与者都经历了显著的学习曲线（首次通过所需总时间：473.1±178.5秒，第五次通过时为321.9±182.0秒；P = 0.02，Wilcoxon检验）。有15名新手和15名内镜专家。观察到这两组在执行各自程序所需的总时间上存在显著差异（首次通过：专家为394.3±176.6秒，新手为531.9±166.7秒；P = 0.040，Mann-Whitney检验）。此外，NOTES胆囊切除术能够成功模拟。参与者认为ELITE是NOTES的一种有用模拟器。
新开发的ELITE训练器是训练NOTES技术的合适工具。可以可靠地区分专家和新手，并且可以证明通过训练有显著进步。
